Gastrointestinal bleeding

What is gastrointestinal bleeding?

Gastrointestinal bleeding can occur in the upper or lower gastrointestinal tract, including your oesophagus, stomach, intestines or rectum.1  Gastrointestinal bleeding can be a symptom of a number of conditions.

Gastrointestinal bleeding is typically classified into the below sub-types:

  • Overt – the presence of blood in vomit, stool or from anus 2
  • Occult – bleeding is not visible and may be identified through presentation of unexplained anaemia (low iron), causing tiredness and breathlessness or positive faecal occult blood test, which tests for the presence of haemoglobin in stool 2
  • Obscure – persistent bleeding in which a source is not identified during colonoscopy or upper endoscopy 2

Signs and symptoms of gastrointestinal bleeding

Signs and symptoms of upper gastrointestinal bleeding may include:

  • Discomfort or bloating in the upper abdomen
  • Blood or coffee ground substance in vomitus
  • Black, tarry stools
  • Bright red blood from the rectum, if bleeding is very severe
  • Unexplained anaemia (low iron), causing tiredness, paleness and breathlessness

Signs and symptoms of lower gastrointestinal bleeding may include:

  • Abdominal discomfort or bloating
  • Rectal bleeding
  • Stale blood or bright red blood in stool
  • Unexplained anaemia (low iron), causing tiredness, paleness and breathlessness

Diagnosis

To diagnose the cause of gastrointestinal bleeding may involve a number of tests. Your doctor may refer you for a blood test to determine your haemoglobin level, platelet count and liver function; you may undergo a faecal occult blood test, which tests for the presence of haemoglobin in your stool; a colonoscopy, a procedure which involves inserting a camera on a flexible tube into the rectum to identify any evidence of lower gastrointestinal bleeding; or an upper endoscopy, a procedure which involves inserting a camera on a flexible tube via the mouth to identify upper gastrointestinal bleeding. 1

For patients with obscure bleeding that have received negative upper and low gastrointestinal endoscopy, further investigation is required.

Treatment

As gastrointestinal bleeding is often a symptom of a wide range of gastrointestinal conditions, treatment will vary upon diagnosis.

Frequently asked questions

What causes gastrointestinal bleeding?

Gastrointestinal bleeding can occur in the upper or lower gastrointestinal tract due to a number of causes. These include:

Upper gastrointestinal bleeding

  • Peptic uclers – occurs when sores develop in the lining of the stomach and intestines as a result of stomach acid, bacteria or anti-inflammatory medication
  • Inflammation of the oesophagus or stomach
  • Varices in the oesophagus or stomach
  • Cancer – malignant tumours in the stomach or oesophagus

Lower gastrointestinal bleeding 

  • Rectal conditions – such as haemorrhoids or anal fissures
  • Cancer – cancerous tumours in the colon or rectum may weaken the digestive tract lining and cause bleeding
  • Diverticular disease – occurs when abnormal small pouches form in the digestive tract
  • Inflammatory bowel disease
  • Abnormal vascular conditions – such as angiodysplasia

References

For a full list of references, click here.
  1. Mayo Clinic (2019). Gastrointestinal bleeding. Accessed 15 November 2019 at https://www.mayoclinic.org/diseases-conditions/gastrointestinal-bleeding/symptoms-causes/syc-20372729
  2. Gralnek, Ian (2005). Obscure-Overt Gastrointestinal Bleeding. Gastroenterology, 128: 1424 – 1430. https://doi.org/10.1053/j.gastro.2005.03.067

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